J Emerg Med
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The pre-endoscopic Rockall Score (RS) and the Glasgow-Blatchford Scores (GBS) can help risk stratify patients with upper gastrointestinal bleed who are seen in the Emergency Department (ED). The RS and GBS have yet to be validated in a United States patient population for their ability to discriminate which ED patients with upper gastrointestinal bleed do not need endoscopic hemostasis. ⋯ Some patients who were identified as lowest risk by the GBS or RS still received endoscopic hemostasis during hospital admission. These clinical decision rules may be insufficiently sensitive to predict which patients do not require endoscopic hemostasis.
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Patients with acute bacterial skin and skin structure infections (ABSSSI) commonly present to Emergency Departments (EDs) where physicians encounter a wide spectrum of disease severity. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased in the past decade, and CA-MRSA is now a predominant cause of purulent ABSSSI in the United States (US). ⋯ The growing prevalence of CA-MRSA associated with ABSSSI in the US has a significant impact on clinical management decisions in the ED. Recent availability of new diagnostic testing and therapeutic options may help meet the demand for effective antistaphylococcal agents.
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Review Case Reports
Fishhook removal: case reports and a review of the literature.
Fishhook injuries are common among people who fish for recreation, but can be encountered in anyone who has handled a fishhook. They represent a unique challenge for Emergency Physicians who seek to remove them without causing further tissue damage from the barbed nature of the hook. ⋯ Understanding the unique nature of fishhook injuries and awareness of techniques to manage them are essential to the practicing Emergency Physician.
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Multicenter Study
Enteroviral testing and length of hospital stay for children evaluated for lyme meningitis.
In Lyme disease-endemic areas, many children with aseptic meningitis are hospitalized while awaiting Lyme serology results. Although Lyme serology takes several days, an enteroviral polymerase chain reaction (EV PCR) test takes only a few hours to return results. ⋯ Rapid EV PCR testing could assist clinical decision making by Emergency Physicians, avoiding potentially unnecessary hospitalization and parenteral antibiotics for children at low risk of Lyme meningitis.